Diabetes mellitus after renal transplantation - As deleterious as non-transplant-associated diabetes?
Diabetes mellitus after renal transplantation - As deleterious as non-transplant-associated diabetes?
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DOI：
10.1097/00007890-199802150-00014
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发表时间：
1998-02-15
期刊：
影响因子：
6.2
通讯作者：
Friedman, EA
中科院分区：
文献类型：
--
作者：
Miles, AMV;Sumrani, N;Friedman, EA
背景尽管在环孢素和他克莫司时代，肾移植术后使用较低剂量的皮质类固醇激素，但移植后糖尿病仍然是一个常见的临床问题。（平均随访，9.3+/-1.5年）肾移植后发生糖尿病的11.8%肾移植人群（n=40）的移植物和患者存活率，结果：糖尿病患者10年移植物存活率为48%，对照组为70（P=0.04），考克斯回归分析显示糖尿病是移植物失功的重要预测因子（P=0.04，相对危险度=3.72）与年龄、性别和种族无关，糖尿病患者5年时的肾功能（通过血清肌酐水平评估）低于对照组患者（2.9+/-2.6vs，2.0 +/-0.07mg/dl，P=0.05），2例发生移植物丢失的糖尿病患者的临床病程和组织学特征与糖尿病肾病一致;移植后糖尿病患者的其他糖尿病相关发病率包括酮症酸中毒、高渗性昏迷或昏迷前期，和感觉运动性周围神经病，糖尿病患者和对照组患者的12年生存率相似结论：移植后糖尿病与移植肾长期存活和功能受损有关，移植后糖尿病可能发生与非移植相关性糖尿病相似的并发症，因此，与非移植相关性糖尿病一样，在移植后糖尿病患者中也需要严格的血糖控制。
Background. Despite use of lower doses of corticosteroid hormones after renal allotransplantation in the era of cyclosporine and tacrolimus, posttransplant diabetes mellitus remains a common clinical problem,Methods, We prospectively investigated the effect of posttransplant diabetes on long-term (mean follow-up, 9.3+/-1.5 years) graft and patient survival in the 11.8% of our renal transplant population (n=40) who developed diabetes after kidney transplantation, and we compared outcome in 38 randomly chosen nondiabetic control patients who had received transplants concurrently,Results, Twelve-year graft survival in diabetic patients was 48%, compared with 70% in control patients (P=0.04), and Cox's regression analysis revealed diabetes to be a significant predictor of graft loss (P=0.04, relative risk=3.72) independent of age, sex, and race, Renal function at 5 years as assessed by serum creatinine level was inferior in diabetic patients compared to control patients (2.9+/-2.6 vs, 2.0+/-0.07 mg/dl, P=0.05), Two diabetic patient who experienced graft loss had a clinical course and histological features consistent with diabetic nephropathy; other diabetes-related morbidity in patients with posttransplant diabetes included ketoacidosis, hyperosmolar coma or precoma, and sensorimotor peripheral neuropathy, Patient survival at 12 years was similar in diabetic and control patients (71% vs, 74%).Conclusions, Posttransplant diabetes mellitus is associated with impaired long-term renal allograft survival and function, complications similar to those in non-transplant-associated diabetes may occur in posttransplant diabetes, and, hence, as in non-transplant-associated diabetes, tight glycemic control may also be warranted in patients with posttransplant diabetes.